Prostate Cancer Flashcards
What is the epidemiology of prostate Ca?
Most common male cancer - c.1/6
Age most common risk factor:
- Subclinical Ca is common in men >50yrs
1st degree relative +ve increases the risk
Increased in BAME
What screening is available for prostate cancer?
There is none - not worth the risk/benefit - instead patients >50 are educated on these and may elect to have a test
How does prostate cancer present clinically?
Typically on the basis of DRE and/or PSA levels
- Hard, irregular, nodular prostate
- Asymmetry
- Adhesion to surrounding tissue
- Palpable seminal vesicles
LUTS are typically only a feature of advanced Ca
Other features of advanced disease:
- Haematuriua, haematospermia
- Perineal and suprapubic pain
- Retention
- Impotence
- Rectal symptoms e.g. tenesmus
- Bone pain or sciatica (from mets)
- Lymph node enlargement
- Weight loss, cachexia
What is PSA and how do you interpret it?
Prostate specific antigen
- Protease that helps breakdown semen in order to make it more liquid
- Produced by epithelial prostatic cells (benign and malignant)
Sensitive but not specific - also raised in response to:
- BPH (most commonly)
- Prostate Ca
- Old age
- DRE exam or urinary catheterisation or TURP or prostate biopsy within 6wks
- Prostatitis or UTI
- Acute urinary retention
- Recent ejaculation or vigorous exercise
Interpretation must factor the above into consideration when interpreting PSA
- Normal range = 0-4nanograms/ml
- Generally - men aged 50-69 with a PSA >3 warrants referral
What other examinations do you perform in prostate cancer?
Urinalysis +/- MC+S - to exclude renal and bladder pathology
U+E - to exclude renal disease
Prostate biopsy:
- Taking into account multiple risk factors not just PSA/DRE
- Transrectal US + needle biopsy (will miss 10-30%) OR transperineal
- USS = hyperechoic area in peripheral zone
- -ve biopsy does not exclude Ca (could just have missed)
MRI for staging +/- isotope bone scans for mets
What scoring systems are used for grading prostate Ca?
TNM
+
Histological grading
- Gleason score according to differentiation of tumour (2 = most well, 10 = most poorly)
What is the most common type of prostate Ca?
Adenocarcinoma arising from the peripheral zone of the prostate
- Slow growing
If they do met, they go to bone and LNs
What are the treatment options for men with prostate Ca?
Low risk, localised Ca:
- Active surveillance OR
- Radical prostatectomy OR
- Radical radiotherapy
Intermediate/high risk:
- Androgen deprivation treatment and radical radiotherapy
What is active surveillance in prostate Ca?
Regular monitoring of patients who might benefit from curative treatment in the future
- Putting it off as treatment has side effects e.g. radiotherapy induced ED
- As it grows so slowly, many men will not notice symptoms and may die with their prostate Ca rather than from it
- Performed by MRI, PSA levels, DRE and prostate re-biopsy - at varying intervals
This is in contrast to watchful waiting = conservative management in patients deemed unsuitable for curative treatment from the outset
What does surgical treatment involve in prostate Ca?
Removal of entire prostate and resection of both seminal vesicles with wide margins of excision and pelvic lymph node dissection
What is androgen deprivation treatment in prostate Ca?
LHRH agonists:
- Goserelin, leuprorelin - lead to castrating levels of testosterone
- Associated with ‘flare phenomenon’ = bone pain, retention, AKI, SCC, hypercoagulable states
- SE: hot flushes (give medroxyprogesterone), sexual dysfunction, osteoporosis, gynaecomastia, fatigue
Anti-androgens:
- Enzalutamide, abiraterone, bicalutamide
Reduces the effects of testosterone and other androgens and thus inhibits progression of tumour
Can be used alone in some cases or as an adjuvant
